Perceptions on Medical Professionalism Among Future Healthcare Professionals: A Mixed Method Study

Background Accreditation councils across the world constantly examine policies and practices in professionalism in their medical curriculum. The National Medical Commission (NMC) in India has recognized the pressing need to reform and include professionalism in its undergraduate curriculum. Objectives The objective of this study was to explore the perspectives of medical and nursing students on professional behavior, suitable teaching-learning methods, and assessment strategies for curriculum integration. Methodology The study utilized a concurrent triangulation mixed method design, collecting both qualitative and quantitative data simultaneously to gain a comprehensive understanding of medical and nursing students' perceptions of professionalism. It included 83 final-year undergraduate medical students and 42 final-year undergraduate nursing students. The approval of the Institutional Review Board of Meenakshi Medical College Hospital & Research Institute was obtained. A semi-structured questionnaire consisting of demographic characteristics and opinions regarding academic professional behavior, teaching-learning, and evaluation of professionalism was used. Perceptions regarding the meaning of professionalism, behavior of professionalism to be emphasized in teaching, and pressing challenges of professionalism were explored. Students were also asked to rank the best behavior associated with professionalism. Frequency and percentages were used for descriptive statistics. Means and standard deviations were calculated for continuous variables. An unpaired t-test was used to determine a statistically significant difference between the means in the two groups. The quantitative data was analyzed with R programming and content analysis was performed for the qualitative data using ATLAS.ti qualitative data analysis software. Results Unexplained/unauthorized absence from academic activities (2.39 ± 1.553), not following the timeline (2.41 ± 1.560), making fun of patients and peers (2.16 ± 1.619), cheating in the exams (2.37 ± 1.651), and inebriation (2.39 ± 1.666) were unacceptable behaviors by undergraduate medical students compared with nursing students. Clinical experience (1.54 ± 0.857) and role models (1.74 ± 0.935) were the highly acceptable methods of teaching professionalism and interprofessional interactions (1.58 ± 0.650) and awards (1.98 ± 1.100) were the most common suggestions to improve the course curriculum by both groups. Community/field activity (1.78 ± 0.860) and clinical examination (1.89 ±1.123) were the most preferred methods of evaluation of professionalism. According to the students, dedication, honesty, respect, and self-improvement were identified as the best behaviors associated with professionalism. Conclusions The study revealed that students had a wide range of perspectives about professionalism. Different unprofessional acts were acceptable to students. The causes of these perspectives need to be explored and resolved to promote professionalism. Students identified the need for strong positive role models and frequent clinical experiences, along with improved interprofessional interactions and awards to improve teaching and learning professionalism. Community/field activity was the preferred assessment method proposed by the students. Medical institutions must promote these components in curriculum, faculty development, and clinical settings to foster the development of professionalism among students.

Incorporating special needs simulations into allied dental education curriculum to encourage inclusion, understanding, and empathy: A mixed method study

OBJECTIVES

Allied dental practitioners increasingly encounter demands specific to treating patients with special needs and disabilities. New standards by the Commission on Dental Accreditation require dental and allied dental graduates to have didactic and skill-based competencies to ensure awareness of and effective treatment and recommendations for these patients. This study sought to determine if adding a special needs simulation activity into allied dental students' curriculum would increase the student's awareness of and comfort level when treating patients with special needs.

METHODS

This mixed-methods study measures student perceptions specific to the efficacy of adding special needs simulations into the allied dental program curriculum. Graduating dental assistants and dental hygienists (n = 65) participated and were paired within their cohort. Didactic instruction specific to the diagnoses of cerebrovascular accident (CVA), macular degeneration, rheumatoid arthritis, schizophrenia, and hearing impairment was provided. Following formal classroom instruction, pairs of students participated in simulation stations, one for each of the listed diagnoses. A pre-/postsurvey was given to evaluate any changes in student perceptions of patients with special needs, and a Student Evaluation of Educational Quality (SEEQ) postsurvey provided to evaluate their perception of the educational activity.

RESULTS

All 65 participants completed the pre- and postsurveys for a 100% response rate, and 61 (93.8%) completed the SEEQ. SPSS software was utilized to run a Wilcoxen Signed Ranks Test to determine significance for each pre-/postsurvey question to determine any statistically significant (p < .05) differences. Means and standard deviations were calculated for each survey item including SEEQ. There were significant differences for each question, and, overall, in participant's perceptions from the presurvey to the postsurvey. Most notable were the positive changes related to the participants' ability to relate to persons with special needs, their awareness of various special needs, and their increased knowledge of available adaptive oral health equipment.

CONCLUSION

In conclusion, students feel better prepared to treat clients with special needs after guided instruction within their respected dental hygiene and/or dental assisting programs. The incorporation of lecture and lab content through simulated activities enhances their perceptions, confidence, and preparedness to effectively treat, accommodate, and educate special needs patient's.

A 10-year longitudinal study of dental students' emotional intelligence and the impact of COVID-19

PURPOSE/OBJECTIVES

Emotional intelligence (EI) supports the clinical and social competencies of a practicing dentist. Reuven Bar-On's EI model is an array of inter-related emotional and social competencies, skills, and behaviors, which consist of five key domains: Self-Perception, Self-Expression, Interpersonal, Decision Making, and Stress Management, and associated with the domains are 15 emotional quotient (EQ) subskills. This study measured the impact of COVID-19 on dental students' EI by comparing measures pre-COVID-19 and during COVID-19 matriculation.

METHODS

This retrospective longitudinal study measured EI with the EQ-i 2.0 for higher education. Dental students completed an EQ-i 2.0 assessment (Attempt) at the beginning of matriculation, at the mid-point, and prior to graduation. Ten groups were included, of which the first three completed matriculation prior to the pandemic and the remaining seven matriculated during timeframes intersecting at different times during the pandemic. A paired t-test dependent sample of means (p ≤ 0.05) compared EQ scores for each attempt for all groups. The study compared means for three EQ attempts with the t-test independent sample of means (p ≤ 0.05) for cohorts matriculating pre-COVID-19 and during COVID-19.

RESULTS

The pre-COVID-19 groups showed significant increases in EQ with each subsequent attempt. COVID-19-impacted groups demonstrated significant increase in Stress Tolerance and significant decreases, most notably in the domains of Interpersonal and Self-Perception, and subscales of Optimism and Happiness.

CONCLUSION(S)

COVID-19-related stressors impacted dental students' EI as multiple EI areas declined significantly. Dental educators should minimize organizational stressors and support EI during years 2 and 3 of matriculation.

Work Ethics and Ethical Attitudes among Healthcare Professionals: The Role of Leadership Skills in Determining Ethics Construct and Professional Behaviors

(1) Background: The provision of healthcare is transforming, necessitating changes in descriptions and frameworks for ethical leadership. This study aimed to assess the association of the different leadership skills with the work ethical constructs and attitudes among healthcare professionals. (2) Methods: A cross-sectional study design using a snowball sampling technique was used to enroll healthcare practitioners. The questionnaire used in this study included two parts: the first part gathered the sociodemographic characteristics of the participants, while the second part consisted of three validated assessment scales, i.e., work ethics, ethical attitudes questionnaire for public health professionals, and leadership skills questionnaire. (3) Results: Higher work ethics and a higher intrinsic work motivation subscale were significantly associated with high leadership administrative skills (Beta = 6.04, p = 0.019, and Beta = 2.55, p < 0.001, respectively). However, higher leadership conceptual skills (Beta = −1.07, p = 0.027) were associated with a lower intrinsic work motivation subscale. Higher leadership administrative skills (Beta = 28.39, p < 0.001) were significantly associated with higher ethical attitudes scores. (4) Conclusions: Higher administrative leadership has an imperative positive impact on work ethic in the provision of different public health services. Leadership skills are not limited to a specific profession, experience, or career stage of health care, and could significantly predict the individual ethical attitude and professional behavior.

Social media use, professional behaviors online, and perceptions toward e-professionalism among dental students

OBJECTIVES

This study aimed to assess self-reported social media use, professional behaviors online, and perceptions on e-professionalism while using social media among dental students in two Southeast Asian universities.

METHODS

This cross-sectional study involved clinical dental students at University of Malaya (UM), Malaysia (n = 150) and Airlangga University (AU), Indonesia (n = 150). A questionnaire was distributed using Google Form via WhatsApp network. Data were analyzed using descriptive, Chi-square, and Wilcoxon rank-sum tests.

RESULTS

All students responded (n = 300) and reported as active social media users. Majority spent ≥ 1 h a day on social media and checked their social media > 6 times a day. Most commonly used social media accounts were Instagram (UM: 92.7%, AU: 95.3%) and Facebook (UM: 94.7%, AU: 59.3%). A small proportion of UM and AU students admitted to posting clinical photographs, patient records, and comments about patients on social media. UM students had significantly better scores in terms of their professionalism behaviors on maintaining the integrity of the profession compared to AU students (p < 0.001). Meanwhile AU students had better scores than UM students on behaviors related to upholding colleagues' professional image on social media (p = 0.421). Most students in UM and AU shared similar positive perceptions toward online professionalism behavior statements. Majority reported concerns over unprofessional posts online.

CONCLUSION

Self-reported behaviors online sometimes contradict with students' perceptions and concerns about being unprofessional online. There is a need for clearer educational guidelines on how to instill e-professionalism values and behaviors among dental students.

Relationship between nursing students' perceptions of clinical instructor caring and their professional behaviors

PURPOSE

To examine the relationship between nursing students' perceptions of clinical instructor caring and their professional behaviors.

METHOD

This study used a descriptive and cross-sectional design. The data were analyzed with Pearson's correlation and Linear regression analyses.

RESULTS

The professional behaviors of nursing students were found to increase their desire to become a nurse in the future with "instills confidence through caring" and "supportive learning climate" subscales but to decrease their desire to be an academician in the future.

CONCLUSION

As students' perceptions of clinical instructor caring increased, their status of applying professional behaviors was found to increase, as well.

PRACTICAL IMPLICATION

Descriptive characteristics and clinical instructor caring are related to high professional behaviors in nursing students.

Examination of the professional values of the nurses and the associated factors

PURPOSE

This study is conducted to examine the professional values of nurses and their personal and professional characteristics affecting these values.

DESIGN AND METHODS

A total of 369 nurses completed a questionnaire on personal information and nursing professional values scale (NPVS-R).

FINDINGS

The total scores of the nurses on the NPVS-R were found to be 100.87 ± 21.07, and the item mean scores were found to be 3.87 ± 0.81. When the scores for individual scale factors were examined, the highest scores were observed for the "caring" (4.02 ± 0.87) and "activism" (3.90 ± 0.89) factors.

PRACTICE IMPLICATIONS

The fact that nurses are aware of their individual values and how these values affect their behavior can be a guide in human-focused value nursing planning.

Assessment of dental residents' professionalism through Professionalism Mini-Evaluation Exercise (P-MEX)

PURPOSE/OBJECTIVES

The aim of the study was to assess the professional behavior of dental residents through Professionalism Mini-Evaluation Exercise (P-MEX).

METHODS

This was a descriptive-analytical study. Content validity of P-MEX form was investigated for use in the context of dentistry. A total of 24-item version of P-MEX consisted of doctor-patient relationship skills (n = 7), reflective skills (n = 5), time management (n = 3), and interprofessional relationship skills (n = 9) was used in the present study. Residents in different dental specialties (n = 56) were evaluated by trained raters (448 times). Data were analyzed by descriptive (mean, SD) and analytical tests (Pearson, ANOVA, and post hoc test (Bonferroni)).

RESULTS

Validity of P-MEX was approved in the field of dentistry. The mean score of professional behavior in residents were reported 2.79 ± 0.24, with minimum and maximum scores of 2.17 and 3.62, respectively. The residents' professional behavior in the domain of reflective skills and doctor-patient relationship skills were lower than the other domains.

CONCLUSION(S)

The results showed that the scores of professional behavior among dental residents were classified in the below expectation level and their scores have followed a downward trend from the second year. Therefore, planning for training and continuous assessment of professional behavior among residents in the faculty of dentistry should be considered.

Educational system defects and observing professional behavior: A qualitative study

BACKGROUND

Observing professional behavior in clinical settings encounters many obstacles. In this research, the effect of defects of the educational system in observing professional behavior in clinical settings of Tehran University of Medical Sciences (TUMS) has been investigated.

MATERIALS AND METHODS

This qualitative content analysis study was conducted using focused group discussions in TUMS. Twenty-two focused group discussions with 182 faculty members, medical students, and clinical staff were conducted. Conventional content analysis was used to analyze the data.

RESULTS

One hundred and sixty codes (90 codes from the viewpoint of clinical staff and 70 codes from the viewpoint of faculty members and medical students) were extracted. The codes are categorized into 4 categories and 17 subcategories. The categories include "educators' imperfections," "inadequate initial training," "lack of attention to continuous professional education," and "lack of passion for professionalism education."

CONCLUSION

Greater efforts to empower educators, planning for the effectiveness of initial education, and motivating employees might play a role in promoting the observance of professional behavior in clinical settings. Professional behavior training should be considered at the entrance into the system. This education should be strengthened by continuing theoretical and practical training and addressed by proper supervision. It is also important to focus on attracting the attention of teachers to their own model role in observing professional behavior by others.

The Use of Social Media by Dental Students for Communication and Learning: Two Viewpoints: Viewpoint 1: Social Media Use Can Benefit Dental Students' Communication and Learning and Viewpoint 2: Potential Problems with Social Media Outweigh Their Benefits for Dental Education

Social media have become a major part of an interconnected society, impacting personal and professional lives. This Point/Counterpoint presents two opposing viewpoints on the question of whether social media should be used in dental education as a learning and communication tool for dental students. Viewpoint 1 argues that social media benefit student learning and should be used as a tool in dental education. This argument is based on evidence concerning use of social media and improved learning across health professions, improved peer-peer communication in clinical education, improved engagement in interprofessional education (IPE), and provision of a mechanism for safe and improved communication between practitioners and patients, as well as faculty and students. Viewpoint 2 argues that potential problems and risks in using social media outweigh any benefits found in learning and therefore social media should not be used as a tool in dental education. This viewpoint is supported by evidence of negative effects on learning, the establishment of a negative digital footprint in the public's view, risk of privacy violations when using social media, and the new phenomenon of Internet addiction with its negative physiological effects on social media users.

Pediatric Dentists' Silver Diamine Fluoride Education, Knowledge, Attitudes, and Professional Behavior: A National Survey

Silver diamine fluoride (SDF) is an inexpensive treatment for arresting cavitated carious lesions in a minimally invasive way. The aims of this study were to assess U.S. pediatric dentists' SDF educational experiences, knowledge, attitudes, and professional behavior and to explore the relationships among these constructs. For the cross-sectional survey, recruitment emails were sent to all 6,230 members of the American Academy of Pediatric Dentistry (AAPD). Responses were received from 582 members (response rate 9.34%). In the results, only 3% of the respondents reported having been well/very well educated about SDF in classroom settings in dental school and only 9.6% during their residency. Positive SDF professional development was reported frequently (education through publications 53%, online resources 41%, continuing education courses 38%). The majority knew much/very much about what SDF is used for in dentistry (77%), about treating caries in pediatric patients (80%), and which problems SDF use can have (62%). Their SDF attitudes were positive: SDF use was considered a good treatment alternative for restorations in children with behavioral problems (85%) and for patients who were medically fragile (85%) or had severe dental anxiety (81%). Among the respondents, 31% used SDF often/very often to arrest carious lesions in primary teeth, and 87% expected increased future SDF use. The more SDF professional education the respondents had, the more self-reported knowledge they had (r=0.52; p<0.001), the more positive their SDF-related attitudes (r=0.25; p<0.001), and the more likely they were to use SDF (r=0.37; p<0.001). These results suggest that expanded education about the proper use, benefits, and limitations of SDF is needed and is likely to increase pediatric dentists' SDF utilization.

Career Outcomes of Dental Hygiene Baccalaureate Education: A Study of Graduates' Professional Opportunities, Further Education, and Job Satisfaction

There is a paucity of studies on Canadian baccalaureate dental hygienists. As discussions about the entry-level education required in dental hygiene continue on national and international platforms, examining outcomes of earning a dental hygiene baccalaureate degree is imperative. The aim of this study was to investigate the professional practice behaviors and career outcomes of graduates of the University of British Columbia (UBC), Canada, Bachelor of Dental Science in Dental Hygiene (BDSc) degree program. UBC dental hygiene entry-to-practice (ETP) and degree-completion graduates from 1994 to 2016 were invited to participate in an online survey with closed- and open-ended questions about practice behaviors and outcomes after earning the BDSc degree. Of the 365 BDSc alumni who received the email invitation, 116 responded, for a 32% response rate. The results showed that 45% of respondents worked outside of the traditional private dental practice setting, specifically in education (23%), administration (9%), public health (8%), and research (5%). Of the 77 degree-completion respondents, 75% reported that the BDSc degree had expanded their career opportunities. A greater proportion of degree-completion respondents practiced outside of the clinical setting (p<0.01) and had earned a graduate degree (p=0.04) compared with ETP respondents. Over 25% of total respondents had pursued graduate education. In comparison to results from the 2015 Canadian Dental Hygienists Association job market and employment survey, a significantly greater proportion of BDSc graduates practiced collaboratively with non-dental professionals (2.7 vs. 0.8, p<0.001), earned more than $80,000 annually (47% vs. 23%, p<0.001), and received more employment benefits (4.0 vs. 3.5, p<0.001). These results highlight the positive impact of baccalaureate education on dental hygiene practice behaviors and career outcomes.

Differentiating Fieldwork Settings: Matching Student Characteristics to Demands

Academic fieldwork coordinators (AFWCs) face the challenge of matching students to Level II fieldwork (FW) sites. This study surveyed 301 fieldwork educators (FWEs) from 30 states to explore how important it was for students to possess 25 characteristics or abilities to enable success at the educators' individual work sites. The top three characteristics and abilities overall were as follows: (1) time management, (2) ability to communicate with supervisor when help is needed, and (3) overall professional behavior. Using Mann-Whitney U-tests for ordinal data, statistically significant differences (p ≤ .01) were found between settings with acute care having the highest expectations of students. Overall results support the value of FW coordinators matching students' abilities to demands of settings prior to Level II FW placements. Top ranking items may also guide schools on admissions criteria and skill development throughout curriculum.

Professionalism among paramedic students: achieving the measure or missing the mark?

BACKGROUND

Professionalism is a pillar of paramedicine. Internationally paramedic curricula emphasize valid assessment of three domains: cognitive, psychomotor, and affective domains (professionalism). Little is reported on competency measures for professionalism specific to paramedicine. Literature suggests that paramedic students, paramedic practitioners, medical directors, and patients believe that professional attributes should have an increased focus.

OBJECTIVE

The objective of this scoping review is to outline valid and reliable assessments that evaluate professional behaviors.

METHOD

This review used Arksey and O'Malley's six-stage scoping methodology. In September 2016, five databases were searched for articles of relevance; these were MEDLINE, Scopus, Google Scholar, PsycINFO/APA, and EMBASE.

RESULTS

A total of 1587 articles were identified after removal of 468 duplicates. Five articles met the inclusion criteria, two of the articles were from the US and three from UK. The studies range from 2004 to 2014. Three different scales were identified but only two were recommended for use. A US-based scale is composed of 11 items and one generic form of professionalism. The UK scale has 77 items and identified 11 factors within 68 items.

CONCLUSIONS

This scoping review serves to describe valid and reliable measures for professionalism among paramedicine by outlining the quantity of instruments evident in the literature. The scoping review aimed to report the scales supporting evidence of validity and reliability. Three scales were identified in a total of five different studies that specifically measured professional attributes in paramedicine. Currently, two scales are available: an evaluation with 11 items and a self-reported questionnaire with 77 items.

Screening for Diabetes in a Dental School Clinic to Assess Interprofessional Communication Between Physicians and Dental Students

If a dental student diagnoses a patient in a dental school clinic as being at high risk of prediabetes or diabetes, the patient should be referred to his or her physician for further diagnostic evaluation, and the physician should send back the evaluation results so that the dental team can optimize treatment and health care choices if the diagnosis is confirmed. The primary aim of this study was to evaluate physicians' responses to written and oral requests for information regarding follow-up diabetes testing. A secondary aim was to evaluate patients' compliance with recommendations to seek medical care after being determined to be at high risk of prediabetes or diabetes in the dental clinic. Based on at least one positive risk factor for diabetes, 74 patients in one U.S. dental school's clinic were screened by third- and fourth-year dental students for prediabetes or diabetes and underwent point of care HbA1C (glycalated hemoglobin) blood tests between June 2014 and June 2015. Patients with an HbA1C value of 5.7% or above were referred to their physicians for follow-up testing. The physician was mailed the patient's HIPAA release and a request for updates to the student regarding the patient's diabetes status. If the physician did not provide the requested information, a dental student telephoned him or her to obtain the patient's diabetes status. Of the 74 patients, 34 (46%) tested positive with HbA1C tests and were referred to their physicians. Of those 34 referred patients, 20 (59%) saw their physicians for additional evaluations within six months of referral. None of the 20 physicians responded to the written requests for information on additional diabetes testing. After one or two telephone requests, all 20 physicians provided the test results. This study found that most of the patients (59%) followed their dental practitioner's advice to seek follow-up care with their physician, supporting the value of conducting these tests in a dental clinic. However, the results also suggested that a single written request may be insufficient to prompt physicians to return those results and that follow-up communication in a phone call may be more effective.

Implications of State Dental Board Disciplinary Actions for Teaching Dental Students About Emotional Intelligence

The primary emphasis in dental education is on developing students' cognitive intelligence (thinking) and technical intelligence (doing), while emotional intelligence (being) receives less emphasis. The aim of this study was to explore a potential consequence of the paucity of emotional intelligence education by determining the level of emotional intelligence-related (EI-R) infractions in state dental board disciplinary actions and characterizing the types of those infractions. For this study, 1,100 disciplinary action reports from 21 state dental boards were reviewed, and disciplinary infractions were classified as cognitive intelligence-related (CI-R) infractions, technical intelligence-related (TI-R) infractions, and EI-R infractions. EI-R infractions were then subcategorized into emotional intelligence clusters and competencies using the Emotional and Social Competency Inventory (ESCI). The results showed that 56.6% of the infractions were EI-R. When the EI-R infractions were subcategorized, the four competencies most frequently violated involved transparency, teamwork and collaboration, organizational awareness, and accurate self-assessment. Understanding the frequency and nature of EI-R infractions may promote awareness of the need for increased attention to principles of emotional intelligence in dental education and may encourage integration of those principles across dental curricula to help students understand the impact of emotional intelligence on their future well-being and livelihood.

Oral Health-Related Complications of Breast Cancer Treatment: Assessing Dental Hygienists' Knowledge and Professional Practice

PURPOSE

Approximately 200,000 women are diagnosed with breast cancer in the U.S. every year. These patients commonly suffer from oral complications of their cancer therapy. The purpose of this study was to assess dental hygienists' knowledge and professional practice related to providing care for breast cancer patients.

METHODS

A pre-tested 43-item survey was mailed to a random sample of 10% of all licensed dental hygienists in the state of Michigan (n=962). The survey assessed the respondents' knowledge of potential oral complications of breast cancer treatments as well as their professional practices when treating patients with breast cancer. After 2 mailings, the response rate was 37% (n=331). Descriptive and inferential analyses were conducted using SAS.

RESULTS

Many dental hygienists were unaware of the recommended clinical guidelines for treating breast cancer patients and lacked specific knowledge concerning the commonly prescribed anti-estrogen medications for pre-and postmenopausal breast cancer patients. Over 70% of the respondents indicated they were unfamiliar with the AI class of medications. Only 13% of dental hygienists correctly identified the mechanism of action of anti-estrogen therapy. Dental hygienists reported increased gingival inflammation, gingival bleeding, periodontal pocketing, xerostomia and burning tissues in patients receiving anti-estrogen therapies. Less than 10% believed that their knowledge of breast cancer treatments and the potential oral side effects is up to date.

CONCLUSION

Results indicate a need for more education about the oral effects of breast cancer therapies and about providing the best possible care for patients undergoing breast cancer treatment.

Dental students' HIV/AIDS-related knowledge, attitudes, and intentions: impact of the U.S. Health Resources and Services Administration's community-based dental partnership program

Access to oral health care for vulnerable populations is one of the concerns addressed by the U.S. Health Resources and Services Administration HIV/AIDS Bureau's Community-Based Dental Partnership Program (CBDPP). The program introduces dental students and residents at several dental schools to care for vulnerable patients through didactic and clinical work in community-based dental settings. This study of the dental students and residents in this program answered three questions: 1) What are their HIV knowledge, attitudes, and behaviors? 2) How has participation in the CBDPP impacted their knowledge, attitudes, and behaviors? 3) Has the intervention affected their work placement decisions and attitudes after graduation, particularly with respect to treating people living with HIV and other underserved populations? A total of 305 first- through fourth-year dental students and first- and second-year residents at five dental schools across the United States completed surveys before and after a community-based rotation and following graduation. Response rates at each of the five schools ranged from 82.4 to 100 percent. The results showed an increase in the participants' knowledge and positive attitudes regarding treatment for patients with HIV and other vulnerable populations post-rotation compared to pre-rotation. Results after graduation found that most respondents were practicing in private settings or in academic institutions as residents but were willing to treat a diverse patient population. These findings support the role of training programs, such as the CBDPP, for expanding the dental workforce to treating vulnerable populations including people living with HIV/AIDS.

Oral health-related complications of breast cancer treatment: assessing dental hygienists' knowledge and professional practice

PURPOSE

Approximately 200,000 women are diagnosed with breast cancer in the U.S. every year. These patients commonly suffer from oral complications of their cancer therapy. The purpose of this study was to assess dental hygienists' knowledge and professional practice related to providing care for breast cancer patients.

METHODS

A pre-tested 43-item survey was mailed to a random sample of 10% of all licensed dental hygienists in the state of Michigan (n=962). The survey assessed the respondents' knowledge of potential oral complications of breast cancer treatments as well as their professional practices when treating patients with breast cancer. After 2 mailings, the response rate was 37% (n=331). Descriptive and inferential analyses were conducted using SAS.

RESULTS

Many dental hygienists were unaware of the recommended clinical guidelines for treating breast cancer patients and lacked specific knowledge concerning the commonly prescribed anti-estrogen medications for pre-and postmenopausal breast cancer patients. Over 70% of the respondents indicated they were unfamiliar with the AI class of medications. Only 13% of dental hygienists correctly identified the mechanism of action of anti-estrogen therapy. Dental hygienists reported increased gingival inflammation, gingival bleeding, periodontal pocketing, xerostomia and burning tissues in patients receiving anti-estrogen therapies. Less than 10% believed that their knowledge of breast cancer treatments and the potential oral side effects is up to date.

CONCLUSION

Results indicate a need for more education about the oral effects of breast cancer therapies and about providing the best possible care for patients undergoing breast cancer treatment.

Clinicians should be aware of their responsibilities as role models: a case report on the impact of poor role modeling

BACKGROUND

Role modeling is an important and valuable educational method. It is predominant throughout (under-)graduate medical education, and attributes of exemplary medical role models are manifold.

AIM

This article describes the impact of poor role modeling on medical students' professional and personal development on the basis of a singular incident at an associated teaching hospital. In addition, scientific literature studying the effect of and the reasons behind poor role modeling in undergraduate and graduate medical education is analyzed and discussed.

RESULTS

To maximize the educational potential of clinical role modeling, medical schools have to consider strategies both on the individual as well as on the institutional level. Several suggestions are offered on both levels.

DISCUSSION/CONCLUSION

Based on a case report of significantly poor role modeling, this article outlines strategies through which academic medical institutions may maximize the educational potential of role modeling and lastingly enhance teaching proficiency of clinical faculty.

Association between dentists' participation in charitable care and community-based dental education

The Institute of Medicine and the Commission on Dental Accreditation (CODA) have recommended that dental schools incorporate community-based dental education (CBDE) programs into their curricula. The expectation is that CBDE participation will help dental students gain the skills and motivation to treat vulnerable populations after graduation. The purpose of this study was to determine whether dentists' involvement with charitable dental care is associated with participation in CBDE as dental students. A questionnaire was mailed to private practice Iowa dentists (N=1,312); the response rate was 41.2 percent (n=541). Logistic regression analyses, controlling for age, gender, number of hours worked per week, graduation year, and alma mater, were conducted. A majority of the respondents provided charitable care: 85 percent in their offices, and 70 percent in the community. Seventy-nine percent had participated in CBDE as dental students. Respondents who reported being very satisfied/satisfied with their charitable care experiences were more likely to provide charitable care in their offices and the community than respondents who were not satisfied with their experiences. Respondents who participated in CBDE as dental students were more likely to provide charitable care in the community than respondents who did not participate in CBDE. The type of sites where dentists completed their CBDE experiences was associated with where they provide charitable care. This study suggests that participation in CBDE may be associated with dental students' providing charitable dental care after graduation.

Integrating issues of substance abuse and addiction into the predoctoral dental curriculum

Methodological discussions about the teaching of substance abuse and addiction in predoctoral dental curricula typically fall short. This article explores the pedagogy employed to present and discuss the relevance of addiction (mostly to illicit drugs) to the dental profession in the first-year predoctoral dental curriculum at the University of British Columbia. These pedagogical approaches are multifaceted and include a role-play scenario with a standardized patient; an interactive guest lecture-based seminar and a community panel of personal testimonials; students' written reflections; and the provision of clinical care to patients with a past or current history of addiction. Students' reflections illustrate the impact of these approaches upon their views of addiction and the dental profession. This pedagogy exposes students to alternative views on substance abuse and addiction, challenges their values and beliefs, and fosters dialogue.

Overview of systematic reviews of the effectiveness of reminders in improving healthcare professional behavior

OBJECTIVE

The purpose of this project was to conduct an overview of existing systematic reviews to evaluate the effectiveness of reminders in changing professional behavior in clinical settings.

MATERIALS AND METHODS

Relevant systematic reviews of reminder interventions were identified through searches in MEDLINE, EMBASE, DARE and the Cochrane Library in conjunction with a larger project examining professional behavioral change interventions. Reviews were appraised using AMSTAR, a validated tool for assessing the quality of systematic reviews. As most reviews only reported vote counting, conclusions about effectiveness for each review were based on a count of positive studies. If available, we also report effect sizes. Conclusions were based on the findings from higher quality and current systematic reviews.

RESULTS

Thirty-five reviews were eligible for inclusion in this overview. Ten reviews examined the effectiveness of reminders generally, 5 reviews focused on specific health care settings, 14 reviews concentrated on specific behaviors and 6 reviews addressed specific patient populations. The quality of the reviews was variable (median = 3, range = 1 to 8). Seven reviews had AMSTAR scores >5 and were considered in detail. Five of these seven reviews demonstrated positive effects of reminders in changing provider behavior. Few reviews used quantitative pooling methods; in one high quality and current review, the overall observed effects were moderate with an absolute median improvement in performance of 4.2% (IQR: 0.5% to 6.6%).

DISCUSSION

The results support that modest improvements can occur with the use of reminders. The effect size is consistent with other interventions that have been used to improve professional behavior.

CONCLUSION

Reminders appear effective in improving different clinical behaviors across a range of settings.